The effect of daily life activities on intraocular pressure related variations in open-angle glaucoma

Acute effects of swimming goggle wearing on intraocular pressure, anterior chamber biometrics, and optic nerve head morphology

Swimming goggles (SG) are widely used in water sports, and this study aimed to evaluate the acute effects of wearing SG on intraocular pressure (IOP), anterior chamber biometrics, axial length (AL), and optic nerve head (ONH) morphology. Twenty-eight healthy young adults participated in this cross-sectional study, with assessed parameters including IOP, central corneal thickness (CCT), anterior chamber depth (ACD), anterior chamber angle (ACA), AL, and optical coherence tomography (OCT) imaging of the ONH, specifically Bruch membrane opening (BMO), Bruch membrane opening-minimum rim width (BMO-MRW), lamina cribrosa depth (LCD), and prelaminar tissue (PLT). Measurements were taken at four time points: before wearing SG, at the 1st and 10th minutes of wearing, and immediately after removal. The results showed a significant increase in IOP at the 1st and 10th minutes of SG wear compared to pre-wear and post-removal values. Additionally, decreases in CCT, ACD, and ACA, along with an increase in AL, were observed while wearing SG. However, these changes reverted to baseline after the goggles were removed. No significant alterations were detected in ONH parameters during the study. The findings suggest that wearing SG induces an acute rise in IOP and changes in anterior segment parameters, likely due to oculopression, but does not appear to affect ONH morphology in the short term. Further studies are needed to investigate any potential long-term effects.

Impact of Environmental Factors on Glaucoma Progression: A Systematic Review

Background

Glaucoma, a leading cause of irreversible vision loss, is characterized by progressive degeneration of retinal ganglion cells. Intraocular pressure (IOP) remains a well-established risk factor, but recent research suggests environmental and lifestyle factors may also play a role.

Objective

This review aimed to evaluate the current evidence on the impact of environmental factors on glaucoma progression.

Methods

We conducted a systematic review following PRISMA guidelines, searching various databases for studies on environmental factors and glaucoma progression.

Results

Our review identified several key findings. IOP remains the most crucial modifiable risk factor. Aerobic exercise and mindfulness practices may lower IOP and provide neuroprotection. Lifestyle modifications like smoking cessation and balanced diets were also emphasized. Studies suggest air pollution exposure, particularly PM2.5, may be associated with an increased risk of glaucoma. However, the studies were primarily observational, and more research is needed to establish causality and elucidate underlying mechanisms.

Conclusion

This review highlights the multifaceted nature of glaucoma, emphasizing the interplay between established risk factors (IOP) and emerging environmental influences (air pollution). Environmental factors hold promise as potential targets for glaucoma prevention and management strategies. Future research should focus on well-designed studies to investigate causal relationships and biological mechanisms.

Systematic review on the impact of exercise on intraocular pressure in glaucoma patients

Due to limited studies, we systematically reviewed evidence on the impact of physical exercise on intraocular pressure (IOP) in glaucoma patients, adhering to PRISMA guidelines. Using MEDLINE/Web of Science, PubMed, and Scopus, we selected English, Portuguese, or Spanish studies excluding case reports and yoga-based interventions. From 1001 records, 15 studies were independently evaluated. Evaluated through the MMAT scoring system, two quantitative randomised controlled studies scored 100% while 13 non-randomised studies averaged 84.62%. Our findings indicated that both aerobic and resistance training led to an immediate IOP reduction post-exercise. However, these findings were largely from single-session experiments. In contrast, the effects of longer-term exercise programmes on IOP varied. Although our review underscores the potential utility of exercise in IOP management, the evidence remains inconclusive due to variations in study design, participant demographics, and exercise parameters. This lack of consistency in the research highlights the necessity for larger, standardised, and longer-term studies to robustly corroborate these preliminary findings.

Psychological Stress and Intraocular Pressure in Glaucoma: A Randomized Controlled Trial

PURPOSE

To evaluate the intraocular pressure (IOP) behavior after applying a standardized protocol to induce psychological stress in patients with primary open-angle glaucoma (POAG).

DESIGN

Randomized controlled trial.

PARTICIPANTS

A total of 39 patients with POAG were included: 18 in the stress group and 21 in the control group.

METHODS

Patients were randomized to undergo the Trier Social Stress Test (TSST) or to be included in the control group. All participants were submitted to a modified diurnal tension curve (DTC) 1-4 weeks before randomization, with 3 IOP measurements performed between 8:00 am and 2:00 pm. We evaluated the response to the TSST by measuring the levels of salivary cortisol, salivary amylase, IOP, mean arterial pressure, and heart rate before, immediately after, and 40 minutes after the TSST. The State Trait Anxiety Inventory (STAI) was applied to evaluate the levels of anxiety at the same time intervals.

MAIN OUTCOME MEASURES

Changes in IOP (mmHg), salivary cortisol and amylase, heart rate, mean arterial pressure, and STAI scores.

RESULTS

At baseline, there were no significant differences between the groups regarding age (P = 0.661), sex (P = 0.669), salivary cortisol (P = 0.104), and mean DTC IOP for the right (P = 0.439) and left (P = 0.576) eyes. We observed a significant mean IOP increase of 3.8 mmHg (right eye; P < 0.001) and 4.1 mmHg (left eye; P < 0.001) when we compared IOP measurements obtained during the DTC and immediately after TSST. Salivary cortisol (5.9 nmol/L; P = 0.004), salivary amylase (323 388 UL; P = 0.004), mean arterial pressure (10.1 mmHg; P < 0.001), and heart rate (12.9 bpm; P < 0.001) also increased significantly after the TSST. In addition, 61.1% (11 of 18) of the patients in the TSST group showed an IOP increase > 4 mmHg following the test. The STAI-state score significantly increased after the TSST compared to baseline (P < 0.001) and decreased from poststress to the recovery period (P < 0.001).

CONCLUSIONS

Patients with POAG present significant elevations of IOP, salivary cortisol and amylase, mean arterial pressure, heart rate, and STAI scores after psychological stress induced by the TSST.

FINANCIAL DISCLOSURES

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

A first-in-human pilot study of a novel electrically-passive metamaterial-inspired resonator-based ocular sensor embedded contact lens monitoring intraocular pressure fluctuations

Glaucoma is a leading cause of blindness with no cure, but early treatment and effective monitoring can often slow the progression of the disease. Monitoring of glaucoma is based on the measurement of intra-ocular pressure (IOP) that is a physiological parameter related to the mechanical state and parameters of the eye. Conventionally, diagnosing and assessing the progression of glaucoma is based on the method of measuring IOP discretely at clinics. Recent studies have demonstrated the importance of continuously monitoring IOP for 24 h to elucidate the effect of circadian rhythm. In this work, a metamaterial-inspired electrically-passive sensor-embedded contact lens is presented to monitor the IOP fluctuations based on a first-in-human pilot study. The sensor inside the contact lens is an electrically passive, metamaterial-based resonator that can be measured using a wearable antenna patch. The system has been tested with six healthy volunteers during an experiment to induce deliberate IOP changes via water-loading and placing the individuals in supine position using a recliner seat. The initial data compared with tonometer measurements suggest that the system can be used to assess the variation of IOP continuously.

The visual field-testing maze and vision maze: Feasible techniques to evaluate visual field loss in animals

Visual field loss due to glaucoma is a severe and concerning problem, leading to limited visual range and poor quality vision. The progression of this loss begins with a para-central arcuate scotoma which eventually advances to a ring scotoma and constricted visual fields in later stages. Currently, no animal model is available for screening this pattern of vision loss. However, we have successfully developed two mazes to evaluate visual field loss - the visual field-testing maze (VFTZ) for peripheral vision loss and the vision maze (VM) for central vision loss. Our studies involved inducing glaucoma in Wistar and Sprague Dawley rats using lipopolysaccharide (LPS) and testing them in VFTZ and VM. We used Latanoprost and dorzolamide eye drops as standard drug candidates during the study. We evaluated the animals for intraocular pressure, retinal vasculature imaging, and anxiety using tonometry, ophthalmoscopy, and light and dark model techniques. Furthermore, we quantified the antioxidant parameters of the retina using UV spectroscopy. Our findings showed that animals with peripheral visual field loss in VFTZ took significantly more time to reach the goal and spent more time within the maze compared to normal or drug-treated animals (P < 0.001). Additionally, animals with compromised central visual field in VM spent more time in a particular arm and changed arms less frequently (P < 0.001) compared to normal or drug-treated animals. Moreover, we observed that glaucomatous rats exhibited elevated anxiety levels and impaired performance in the mazes, emphasizing the impact of vision loss on anxiety. Finally, the antioxidant and ATPase alterations in the retinal layers verified the glaucomatous changes in the experimental animals. Based on our remarkable findings, we strongly recommend the use of VFTZ and VM to evaluate visual field loss in animals.

Continuous 24-hour intraocular pressure monitoring in normal Chinese adults using a novel contact lens sensor system

AIMS

To investigate the physiological nyctohemeral intraocular pressure (IOP) rhythms of normal Chinese adults using a novel contact lens sensor system (CLS) that can output IOP in millimetres of mercury (mm Hg) continuously.

METHODS

Fifty-nine eyes of 59 normal Chinese adults completed 24-hour IOP monitoring using the novel CLS. A descriptive analysis was conducted on the 24-hour IOP mean, peak and acrophase, trough and bathyphase, fluctuation, and mean amplitude of intraocular pressure excursion (MAPE). The continuous data were analysed at several periods (diurnal period, 08:00-20:00 hours; nocturnal period, 22:00-06:00 hours; sleep time, 0:00-06:00 hours), and compared between right and left eyes, males and females, and different age ranges (<30, and ≥30), respectively.

RESULTS

Normal adults had a lower peak, higher trough, smaller fluctuation and smaller MAPE (p<0.05 for all comparisons) but non-significantly different mean (p=0.695) in the nocturnal period or sleep time compared with the diurnal period. The 24-hour IOP peak and trough showed the frequency of occurrence ranging from 1.69% to 15.25% at an interval of 2 hours. No IOP parameter showed significant difference between right and left eyes (p>0.1 for all comparisons). The male group had larger 24-hour and diurnal IOP fluctuation and MAPE (p<0.05 for all comparisons). Subjects aged 30 or over had higher 24-hour and diurnal mean, higher peak, and larger MAPE (p<0.05 for all comparisons).

CONCLUSION

Continuous 24-hour IOP output from the CLS in normal Chinese was stable with a comparable mean level between day and night, as well as scattered acrophase and bathyphase. The 24-hour IOP mean increased with age, and IOP variations were positively correlated to age and male sex.

Advancements in Wearable and Implantable Intraocular Pressure Biosensors for Ophthalmology: A Comprehensive Review

Glaucoma, marked by its intricate association with intraocular pressure (IOP), stands as a predominant cause of non-reversible vision loss. In this review, the physiological relevance of IOP is detailed, alongside its potential pathological consequences. The review further delves into innovative engineering solutions for IOP monitoring, highlighting the latest advancements in wearable and implantable sensors and their potential in enhancing glaucoma management. These technological innovations are interwoven with clinical practice, underscoring their real-world applications, patient-centered strategies, and the prospects for future development in IOP control. By synthesizing theoretical concepts, technological innovations, and practical clinical insights, this review contributes a cohesive and comprehensive perspective on the IOP biosensor's role in glaucoma, serving as a reference for ophthalmological researchers, clinicians, and professionals.

Effect of Muslim Prayer (Salat) positions on the intra-ocular pressure in healthy young individuals

Purpose

There is a lack of research examining the effects of Muslim prayer (Salat) positions on the intra-ocular pressure (IOP). Considering its involvement with postural changes, this study aimed to investigate the changes in the IOP upon assuming Salat positions before, immediately after, and after 2 minutes of prayer in healthy young adults.

Methods

This prospective, observational study recruited healthy young individuals aged between 18 and 30 years. The IOP measurements were obtained in one eye using Auto Kerato-Refracto-Tonometer TRK-1P, Topcon at baseline before assuming prayer positions, immediately after, and after 2 minutes of the prayer.

Results

Forty female participants were recruited, with a mean age of 21 ± 2.9 years, a mean weight of 59.7 ± 14.8 (kg), and a mean body mass index (BMI) of 23.8 ± 5.7 (kg/m2). Only 16% had a BMI ≥25 kg/m2 (n = 15). All participants started with a mean IOP at baseline of 19.35 ± 1.65 mmHg, which increased to 20 ± 2.38 mmHg and declined to 19.85 ± 2.67 mmHg after 2 minutes of Salat. The difference between the mean IOPs at baseline, immediately after, and after 2 minutes of Salat was not significant (p = 0.06). However, there was a significant difference between the baseline IOP measurements and those immediately after Salat (p = 0.02).

Conclusion

A significant difference was found between the IOP measurements at baseline and immediately after Salat; however, this was not clinically significant. Further investigation is warranted to confirm these findings and explore the effect of a longer duration of Salat in glaucoma and glaucoma suspect patients.

Psychological interventions to reduce intraocular pressure (IOP) in glaucoma patients: a review

PURPOSE

Glaucoma has been increasing recognised to cause significant mental health burden to patients while psychological factors also play important roles in the development and progression of glaucoma. This review presents the current evidence of the impact of psychological interventions in glaucoma patients to improve their holistic care in terms of both physical and mental health by modulating psychological symptoms and supporting glaucoma control.

METHODS

A literature search was conducted on PubMed for relevant studies up to February 2022. Types of psychological interventions include meditation, autogenic relaxation, music, hypnosis, motivational interviewing, psychological nursing and bright light exposure. Outcomes investigated were ocular parameters including intraocular pressure, mental health, patient motivation and satisfaction, and overall quality of life.

RESULTS

Seventeen studies investigating the effects of psychological interventions on improving the care of glaucoma patients were reviewed. Daily meditation for 30 to 60 min has been shown to be effective in improving glaucoma control in terms of reducing intraocular pressure by 1.5 to 6.1 mmHg and improving ocular perfusion and quality of life. The impacts of music, autogenic training and psychological nursing on glaucoma control, vision outcomes and psychological symptoms are also promising while bright light exposure has shown some effects on sleeping quality. However, there is insufficient basis to support the adoption of motivational interviewing or hypnosis in glaucoma patients yet.

CONCLUSION

Psychological interventions, especially meditation, can play a bigger role in the holistic care of glaucoma patients by controlling disease progression as an adjunct to conventional approaches and alleviating the mental health burden caused by the disease through stress reduction and emotional regulation. They empower patients to gain greater control of their disease and provides additional advantages of low cost, non-invasiveness and minimal side effects. Future research should involve well-conducted randomised trials with larger sample sizes and longer duration of intervention and follow-up to establish the long-term benefits for glaucoma patients.

Effect of yoga on intra-ocular pressure in patients with glaucoma: A systematic review and meta-analysis

Glaucoma is the second leading cause of blindness in the world, with an estimated 57.5 million people suffering from glaucoma globally. Treatment of glaucoma focuses on lowering intra-ocular pressure to prevent progression of visual field defects, which is the only proven method for treating this disease. Yoga practices are believed to lower intra-ocular pressure in the eyes and prevent further damage in patients with glaucoma. Therefore, this systematic review was planned to explore the available scientific studies on yoga and intra-ocular pressure in glaucoma patients. PubMed, Cochrane Library, and Google Scholar were the basis for the investigation of the literature. The Jadad Scale was used to assess the quality of included clinical trials, and the JBI Critical Appraisal Checklist was used to assess the quality of included case studies. Based on the quality assessment and eligibility, six studies on yoga and intra-ocular pressure in glaucoma patients carried out between 2007 and 2021 were included in the final review. The results showed a reduction in intra-ocular pressure in patients with glaucoma through Jyoti-trataka (gazing steadily on a point or candle flame) and some other slow yogic breathing techniques, whereas studies on inversion Asanas (yoga postures) showed a rapid increase in intra-ocular pressure soon after starting. The three high-quality RCTs included in the meta-analysis showed a greater improvement in intra-ocular pressure in the yoga groups in both eyes than in the control groups; however, there were some limitations related to a small sample size, study quality, a long-term follow-up period, and variations in the yoga practices. Therefore, further studies with larger sample sizes and long-term follow-up are needed to overcome the limitations for a better understanding.

Vascular dysregulation in glaucoma: retinal vasoconstriction and normal neurovascular coupling in altitudinal visual field defects

Purpose

Vision loss in glaucoma is not only associated with elevated intraocular pressure and neurodegeneration, but vascular dysregulation (VD) is a major factor. To optimize therapy, an improved understanding of concepts of predictive, preventive, and personalized medicine (3PM) is needed which is based on a more detailed understanding of VD pathology. Specifically, to learn if the root cause of glaucomatous vision loss is of neuronal (degeneration) or vascular origin, we now studied neurovascular coupling (NVC) and vessel morphology and their relationship to vision loss in glaucoma.

Methods

In patients with primary open angle glaucoma (POAG) (n = 30) and healthy controls (n = 22), NVC was studied using dynamic vessel analyzer to quantify retinal vessel diameter before, during, and after flicker light stimulation to evaluate the dilation response following neuronal activation. Vessel features and dilation were then related to branch level and visual field impairment.

Results

Retinal arterial and venous vessels had significantly smaller diameters in patients with POAG in comparison to controls. However, both arterial and venous dilation reached normal values during neuronal activation despite their smaller diameters. This was largely independent of visual field depth and varied among patients.

Conclusions

Because dilation/constriction is normal, VD in POAG can be explained by chronic vasoconstriction which limits energy supply to retinal (and brain) neurons with subsequent hypo-metabolism ("silent" neurons) or neuronal cell death. We propose that the root cause of POAG is primarily of vascular and not neuronal origin. This understanding can help to better personalize POAG therapy of not only targeting eye pressure but also vasoconstriction to prevent low vision, slowing its progression and supporting recovery and restoration.

Trial registration

ClinicalTrials.gov, # NCT04037384 on July 3, 2019.

The Effect of Specific Techniques of Nasal Breathing [Pranayama] on Intra-Ocular Pressure in Normal Individuals, a Randomized Trial

PURPOSE

Glaucoma is an optic neuropathy where intraocular pressure is the only modifiable risk factor. Yoga is thought to adversely affect intra-ocular pressure (IOP) but we do not know if yogic breathing exercises can influence IOP. With this study, we aimed to determine the effect of specific nasal breathing techniques on intra-ocular pressure in normal individuals.

PATIENTS AND METHODS

One hundred and sixty-four normal subjects were randomly assigned to one of four specific breathing groups - right nostril breathing (RNB), left nostril breathing (LNB), alternate nostril breathing (ANB), normal breathing (NB). The IOP was measured in both eyes at baseline and following the breathing exercise; and the change was analyzed.

RESULTS

Eighty-five women and 79 men participated and there was no significant difference in baseline age or IOP between the groups. In RNB, IOP reduced significantly in both right and left eyes, from 14.3 ± 3.0mmHg to 13.9 ± 2.6mmHg, (p=0.022) and from 14.7 ± 3.2mmHg to 14.2 ± 3mmHg (p=0.016) respectively. In LNB, there was no significant IOP change in the right eye, whereas in the left eye, there was a significant reduction from 14.2 ± 2.7mmHg to 13.3 ± 2.5mmHg (p< 0.0001). There was no significant IOP change in ANB and NB.

CONCLUSION

Specific breathing techniques like right and left nostril breathing, alternate nostril breathing are safe and do not raise IOP in normal subjects. Additionally, right and left nostril breathing techniques have a beneficial effect of lowering IOP.

Mental health and self-management in glaucoma patients during the COVID-19 pandemic: a cross-sectional study in China

PURPOSE

To investigate mental health and self-management in glaucoma patients during the COVID-19 pandemic in China and to describe the correlation between anxiety, depression, glaucoma, and self-management.

METHODS

This cross-sectional study included glaucoma patients who enrolled in the case management platform and completed an online survey. The survey included the Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9), and Glaucoma Self-Management Questionnaire (GSMQ).

RESULTS

Among 109 glaucoma patients enrolled in this study, the proportions of patients suffering from depression and anxiety during the COVID-19 pandemic were 26.6% and 20.2%, respectively. A statistical association was found between depression and self-management behaviour in these glaucoma patients (r = -0.247, P = 0.010). The self-management scores in patients less than 35 years were lower than those in patients aged 35-60 years (P = 0.046). The scores of body function promotion in men were lower than those in women (P = 0.048). Patients with primary school education and below had lower scores in the medical management of disease than those with either middle school education (P = 0.032) or community college education or higher (P = 0.022).

CONCLUSION

A high proportion of anxiety and depression was found in glaucoma patients during the COVID-19 pandemic. Better self-management behaviour was associated with stronger mental health regulation. It is important to help glaucoma patients improve their self-management behaviours, especially for young men with low educational levels.

Association of Exercise Intensity with the Prevalence of Glaucoma and Intraocular Pressure in Men: A Study Based on the Korea National Health and Nutrition Examination Survey

Adequate exercise is essential for maintaining a healthy lifestyle and preventing ageing-related diseases. The purpose of this study was to assess the associations between exercise and glaucoma, as well as exercise and intraocular pressure (IOP) levels. This study used data from the Korea National Health and Nutrition Examination Surveys 2008–2012, which in total included 10,243 men aged ≥40 years. The presence of glaucoma and the higher IOP of each eye (IOPmax) taken from the health examination survey and the ophthalmic examination were used for analyses. A questionnaire was used to assess exercise activity, which was analysed regarding intensity, frequency, and duration. Regression analyses were used to determine the relationships of exercise parameters with the odds of glaucoma and IOPmax. The prevalence of glaucoma was significantly lower in men who engaged in moderate-to-vigorous intensity exercise compared to those who did not exercise (p = 0.012). The odds for glaucoma were the lowest in men engaged in vigorous intensity exercise (p = 0.009). However, IOPmax was highest in the vigorous intensity exercise group (p = 0.026) with no linear trend pattern. These results suggest that exercise decreased the odds of glaucoma via several factors including non-IOP mechanisms.

Short-term effects of two types of goggles on intraocular pressure and anterior eye segment biometrics

Background

To evaluate and compare the changes in intraocular pressure and anterior eye segment biometrics during and after wearing two types of commonly used swimming goggles.

Methods

In a cross-sectional study, a total of 40 healthy adults aged between 18 and 60 years old were selected to wear two kinds of common swimming goggles (ocular socket and orbital goggles). Intraocular pressure and anterior segment biometry were evaluated before wearing, at 2 and 5 min of wearing, and at 5 min after removing the goggles. Intraocular pressure (IOP), corneal front keratometry values (K1, K2, Km), central corneal thickness (CCT), central anterior chamber depth (ACD), anterior chamber volume (ACV), and anterior chamber angle (ACA) were measured.

Results

The IOP at 2 min (21.0 ± 2.2 mmHg) and 5 min (21.2 ± 2.3 mmHg) was significantly higher than before wearing goggles (17.7 ± 2.1 mmHg). The IOP after the goggles were removed and at 5 min after the goggles were removed was 18.4 ± 2.3 mmHg and 17.7 ± 2.1 mmHg, respectively. ACV, ACD, and ACA values all decreased while the googles were worn. After the goggles were removed, these changes gradually returned to baseline values, with no significant difference in the values before and after.

Conclusion

This study proves that wearing orbital goggles can lead to an acute increase in IOP and a slight decrease in ACV, ACD, and ACA. However, once the goggles are removed, these indicators return to baseline levels, showing that wearing orbital goggles has no significant lasting effect on IOP and anterior segment parameters.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12886-022-02308-y.